Registered dietitians might be the first person that a client with an eating disorder turns to for help. Think about it. We are the food people. So, if someone is curious about food or struggling with their relationship with food, why not see a dietitian? This blog will cover 7 eating disorder screening questions for dietitians.
Dietitians across the world have so many different awesome specialities. This is what makes our field so cool! While we might not all specialize in eating disorder recovery nutrition, it is so important for dietitians to screen ALL our clients for eating disorders. A reminder that eating disorders do not discriminate by age, weight, ethnicity, race, gender or socioeconomic status. So even if we *think* a client might not be struggling with an eating disorder because they do not fit the stereotype, but they are in fact deeply struggling with their relationship with food.
I remember my dietetic schooling did not go in depth about eating disorders. We had maybe one class about eating disorders, but it wasn’t helpful for practical use in the field. I hope that schooling is different now! But under the assumption that it’s not, let’s get into 7 screening questions dietitians should use with clients to screen for an eating disorder.
Eating Disorder Screening Questions for Dietitians:
Does my client have a history of dieting?
Dieting is a huge predictor of disordered eating/eating disorder behaviors. I looked up some statistics – found from NEDA’s Website. According to one large study, dieting is the “most important predictor” of a 14 or 15 year old girl developing an eating disorder. Those who engaged in “moderate” dieting were 5x more likely to develop an eating disorder. All teens are at risk for getting fed diet information. Whether they learn about dieting in health class or from parents or friends, we must be on guard as dietitians. While all kids are at risk for beginning a diet, kids and teens that are at a greater risk. As well as those who have been told they need to lose weight or diet by a doctor. It’s always a good idea to ask your clients – regardless of age – about their dieting history and their relationship with food growing up.
If my client is an adolescent, have there been big changes on their growth curve (or a stagnant growth curve)?
Are you a dietitian working with adolescents or kids? It’s always a great idea to take a look at their growth curves. I would recommend asking their parents to sign a release to chat with your client’s pediatrician. The office can easily fax growth charts to you!
Adolescents are supposed to generally follow their individual growth curve. And each child’s growth curve is individual and unique to them. This means if a client has been at the 85th percentile for most of their life, they need to remain at the 85th percentile throughout their teen years. Bodies are meant to be diverse! Not everyone is supposed to be at the 50th percentiles.
So, if you notice any drastic changes on a client’s growth curve (especially dropping off the curve and settling at a lower percentile) or a stagnant growth curve, it might be time to check in. I’d ask the parents if they’ve noticed changes in their child’s eating behaviors, mood or how they talk about their body. You can of course check in with the teen about any changes in how they think about food, their exercise habits, or if they have modified their eating in any way.
Does my client feel guilty if they take a rest day with exercise?
Just as we discuss food with our clients, we also want to ask them about their exercise routine. For many clients, drastic increases in exercise can show a disordered relationship with exercise. It’s important we’re asking them screening questions about their relationship with movement. Asking about movement will also help us get a better idea of appropriate nutrition recommendations. And whether or not a client is eating enough for the movement they are participating in.
Here are some questions you may want to consider:
- How often do you exercise?
- What happens if you are injured or hurt?
- Do you exercise when you are tired or feel sick?
- What happens when you go on vacation? Do you continue to exercise or take a couple of days off?
- How do you feel if you take a day off from exercise?
- How are food and exercise related for you?
- Does your relationship with exercise feel compulsive or obsessive?
These are just some questions to get you started. You may not need to ask your clients all these questions. But, if you’re sensing a client feels guilty with off days, is exercising when sick or injured, or is compulsive, you might want to dig deeper. There could be a disordered pattern present. Our clients overall should exercise because it brings them joy and peace – not because it feels like an obligation.
Has my client cut out food groups or specific types of food for non medical reasons?
Another eating disorder warning sign is cutting out specific foods or food groups without a medical reason. Of course, if the client genuinely doesn’t like the food, that’s a different story. It is important to do a little digging as to why a client isn’t eating a certain food. If it’s because of a medical reason, ask if you can speak to their doctor. Or confirm if they were actually testing for a food allergy (or willing to get tested).
If you find that clients aren’t eating desserts or fried foods or other foods that diet culture deems “unhealthy” that could be a red flag for disordered eating.
Ask your client: Does what you ate earlier affect what you eat later?
Clients who compensate with their eating are often struggling with their relationship with food. An example of this might be, not having dessert after dinner because they already had a dessert after lunch. Or basing what they eat for a snack or meal later in the day on what they ate earlier in the day. This removes our clients from being intuitive and truly listening to their body’s needs. And puts external rules and values on their food intake.
Ask your client: Do you avoid social situations due to food?
Food is a huge part of culture and social gatherings! Think about it. When you want to catch up with a friend or see a family member, you usually do this over food or drinks. If our clients avoid social gatherings, overthink them or compensate before/after eating at these events, it could be an eating disorder warning sign. We should be able to enjoy eating with loved ones without the burden of overthinking food or feeling guilty. This is absolutely an important screening question to ask.
Ask your client: Does body image affect what you eat?
Eating less or choosing “healthier” options on a “bad body image day” could be a sign of disordered eating. It’s important we honor our bodies’ hunger, fullness and craving signals regardless of how we think we look. If a client is not eating enough, adjusting what they are eating, or feels guilty about food because of their body image, they are likely struggling with their relationship with food and body.
What to do next?
Dietitians aren’t meant to specialize in everything. It’s okay to refer out. For example, I have never worked with kidney disease. I am not a renal dietitian and could do great harm with my recommendations because I am not familiar with the most up to date research. The same goes for eating disorders. If you are not an eating disorder dietitian, that is 100% okay! Do some research and look for a dietitian in your area who is an eating disorder specialist.
Additionally, Bobbi Boteler and Alex Raymond also provide eating disorder supervision for dietitians looking for case consultation on eating disorder nutrition support. Please visit our supervision and business coaching page for more information.
Courage to Nourish Reminders
Courage to Nourish is an eating disorder specialized nutrition practice located in Columbia, Maryland, College Park, Maryland and Alexandria, Virginia. Our eating disorder dietitians provide eating disorder nutrition support in Maryland, Virginia, Pennsylvania, Colorado, and Washington DC. If you’re interested in any of our individual nutrition services or group services, please give us a call at 301-202-4532 or contact us via email. We’re happy to support you and your recovery.
Helping my clients cultivate meaningful connections and interests outside of their eating disorder is a true passion of mine. I like to think my clients and I are on a team to navigate recovery. I love working with high school and college students as well as athletes seeking to have a better relationship with exercise. I am a proud anti-diet dietitian and work with my clients through a Health At Every Size © and intuitive eating framework.